Specialized care for children reaches new heights

8/19/2014 9:15 AM
By Associated Press

FORT WORTH, Texas (AP) — The medical team moved quickly and deliberately over the baby. Steady and smooth, they comforted, measured and tried to heal.

Raylynn Martinez, just 11 days old, had been running a fever of 103 when her mother, Casey Daugherty, brought her to the ER in her hometown of Bridgeport. Physicians decided she needed to be transferred to Fort Worth's Cook Children's Medical Center.

Enter the Teddy Bear Transport, a fleet of 15 nurses, paramedics and respiratory therapists who perform daily miracles while transporting sick and injured children to Cook Children's from all over the world.

The team is part of what's become the new standard for pediatric and neonatal emergency care — transport teams moving from local hospitals to regional, specialized hubs like Cook Children's.

On this day in Bridgeport's small emergency room, the team consisted of Deana McLelland, a registered nurse; Johnny Perez, a respiratory therapist; and Matt Asay, a paramedic. They worked quickly to prepare the newborn for the hourlong ambulance ride to Fort Worth.

"It's different than 911 — you're in a controlled environment," Asay said. "We try to do everything we can before we hit the road."

He leaned over the adult-size ER bed to Raylynn, cleaning her hand with an alcohol swab while McLelland stroked her head. They had to put in an IV, finding a vein in the tiny hand with a tiny needle. They put some sugar solution on Raylynn's pacifier, helping to soothe the baby.

"Here we go, Princess, gonna give you a little boo-boo," McLelland cooed. Asay prepped the needle and poured some more sugar solution into Raylynn's mouth.

"What, are you trying to win her over?" McLelland asked.

The paramedic steadied the baby's hand and slipped the needle under her thin skin.

Answering the call

When doctors across Texas realize that their young patients need care they can't provide, they call the transport teams of Children's hospitals. Jets, propeller planes, helicopters and ambulances loaded with pediatric and neonatology equipment ferry sick kids from hospital to hospital.

Pediatric care is a regional endeavor, said Bryan Sperry, president of the Children's Hospital Association of Texas. Most hospitals around the country don't have experts in pediatric and neonatal care, so they transfer patients to larger regional hospitals like Cook Children's. For the most part, Cook Children's looks west from Fort Worth, staying mainly in Texas, while other hospitals, such as Children's Medical Center Dallas, look east.

"Kids have all kinds of really strange things that are hard to diagnose," Sperry told The Dallas Morning News (http://bit.ly/1By9s0j ). "You develop over time these specialized capacities, and that includes transport."

Those specializations are driving more community hospitals to rely on teams like the Teddy Bear Transport, experts say.

Calling a children's hospital for transport can help prevent wrong diagnoses, said Jonathan Godfrey, a transport nurse at Children's National Health System in Washington.

In the 15 years he's been there, he's seen the number of such transports at his hospital increase annually from around 1,500 to 6,500.

"There's less and less of pediatric speciality out there in the community," Godfrey said. "We continue year after year to expand our team just to meet the needs of our community."

Since the early 1980s, the Teddy Bear Transport team has transferred patients from as far as Switzerland. But the majority of their calls come from anywhere from the Red River in the north to Waco in the south.

In their hangar at Fort Worth's Meacham International Airport, fueled and ready to roll, are five ground ambulances, an EC145 medical helicopter, a King Air B200 dual-propeller, fixed-wing plane and a brand new Citation Encore Plus jet.

When a call comes in, dispatchers decide how the team will get there based on the status of the patient and distance to destination, load the proper vehicle and head out.

The vehicles are already set up to be more welcoming for younger patients — the ambulance comes equipped with storybooks, Children's DVDs and diapers in every size.

"I love every day (that) I don't know where I'm going to go, who I'm going to meet," McLelland said. "I feel very blessed to do what I do at a family's worst moment and hopefully make a difference."

Stabilizing Raylynn

Asay had the IV in place within minutes. They started giving little Raylynn fluids — a high fever can dehydrate anybody, and babies don't have much fluid to spare.

Daugherty, who had left the room to let the team work, came back to check on her daughter.

"She's a good baby," McLelland said to the new mother.

"She didn't even cry," Asay assured her.

"I might go outside. I get nauseous," the mother said. She left her baby's side and headed for the waiting room but stopped. She turned back, but before entering the room, she turned around again.

"I thought I was ready," she said.

When the mother did return, McLelland was rubbing a swab covered in brown iodine onto the baby's right arm.

"What's that stuff?" the mother asked.

"To clean it," McLelland explained. "Like a brown soap."

She needed to take a blood sample to create blood cultures for doctors at Cook Children's to study and prescribe treatment.

"Now this is going to hurt, Raylynn," the nurse said as she pushed another needle into her arm, prompting a wail from the infant. "Oh, yeah, you don't trust us anymore, do you?"

McLelland held the needle steady while Asay pulled the blood into a syringe.

Fevers in infants mean they are more susceptible for deadly diseases like meningitis. Even though the fever was breaking, doctors would have to watch Raylynn overnight to make sure nothing went wrong with her.

"OK, let's get in your little house," Perez said, lifting Raylynn up, making sure to get all the tubes and bandages attached to her body. He turned to Daugherty, who was watching from the corner of the room. "Wanna give her a little kiss?"

He held the child out to her mother, as Daugherty leaned over, stroking Raylynn's head and giving her three quick smooches on the forehead.

Asay pressed a button and the Isolette blinked to life. Perez placed Raylynn in the pod, bright white light showering over her.

"Rock on, boys," McLelland said when everyone was ready, leading the procession out of the ER and into the ambulance.

Transferring care

At the emergency department at Cook Children's Medical Center, the team rolled the Isolette and stretcher into a room labeled the Critical Decision Unit.

While McLelland gave a summary of treatment to a Cook Children's nurse, Perez lifted Raylynn out of the Isolette and handed her back to Daugherty.

The nurse came in and began to ask the mother questions as she changed Raylynn's diaper. Daugherty wiped the baby's bottom with a wet cloth and answered the questions.

In the hallway, Perez and Asay were already getting ready for their next run. Perez wiped the surface of the Isolette with an alcohol swab while McLelland finished filling out Raylynn's medical chart.

With more than 2,400 transports at Cook Children's each year, it's impossible to get attached to each child. They have to balance caring for their patients with keeping a critical distance to do their jobs properly.

"There are those few we follow up with, then there are those we never see again," Perez said.

McLelland said she connects most with a patient when she sees some kind of personal connection to or reminder of her own life.

"I'll tell you when the emotion part comes in — when it's yours," McLelland said. "Your kid's name. Your kid's birthday. But if we took every story to heart, we wouldn't be able to come back each day."

The team drove back to Meacham, unloaded the ambulance and, around 2 p.m., another call came in. This time they'd be headed to McAllen, in the Rio Grande Valley. They'd take the new jet. The trip would take two hours in the air.

At the medical center, Raylynn was being treated. She would stay in Fort Worth for a few days before being released with a clean bill of health.

Asay and Perez loaded the stretcher, just like they had that morning. The three took their seats inside and buckled up in the hot jet cabin.

The engines let out an ear-piercing squeal as the jet pulled onto the runway. The pilot pushed the throttle forward, sending the jet down the runway. In their blue flight suits, the medical team lifted off, heading south.